Complications of the Diabetic Foot

People with diabetes are at a high risk for both problems of the feet and amputations which are a direct result of angiopathy, neuropathy, and infection. Anyone with diabetes is at a high risk for an amputation of a lower extremity but those who have had diabetes for 10 or more years, are male, have poor glucose control, or have some form of cardiovascular, retinal, or renal problems are at an even greater risk of diabetic foot problems.

Arteriosclerosis is the primary reason that people with diabetes experience vascular changes in their lower extremities. Diabetes induced arteriosclerosis tends to occur at an earlier age, occurs equally in males and females, is usually bilateral, and progresses more rapidly. The blood vessels below the knee are the most likely do be affected. The large, medium, and small arteries of the lower legs and feet are all affected by blockages. Multiple occlusions with decreased blood flow result in the manifestations of peripheral vascular disease.

There are multiple problems associated with diabetic neuropathy of the foot. Diabetics who have some sort of foot trauma may not be aware that they have hurt themselves because their sense of touch and perception of pain no longer exists. The diabetic is thus at an increased risk for tissue trauma to the feet which can lead to ulcer development. This traumatized or ulcerated tissue is at a high risk to develop an infection.

There are many potential sources of diabetic foot trauma but the most common ones are cracks and fissures caused by dry skin, or infections caused by athlete's foot, blisters caused by improperly fitting shoes, pressure from socks, stocking or shoes, ingrown toenails, and direct trauma. The problem for people with diabetic neuropathy is that once they lose the perception of pain they become unaware that these types of injuries have occurred. They will also begin to dissociate from or ignore the affected body part, so that an injury will go unattended for days or even weeks. If the neuropathy is severe enough the injury may be completely forgotten.

A superficial skin ulcer is the first step for a developing skin lesion. Given enough time and left untreated the ulcer will extend deeper into the muscle and bone, leading to abscesses or osteomyelitis. Gangrene can develop in the toes; if this is not treated the whole foot will eventually become gangrenous leaving no option but to amputate the toes or foot.